Pediatric Pain, Stress, and Addiction

“There is no visible blood test or X-ray to show a trauma [or stressor]. I do not look sick.” –Chronic pain patient1

What are the links between stress, addiction, and chronic pain, and how do we understand the ways these experiences affect our most vulnerable population—children? Studies show that more than 50–80% of child maltreatment cases go unreported.2 Even in children who have not experienced a trauma, stress assessment and management often remain unaddressed.3

In 2010, the American Psychological Association found that parents’ perceptions of children’s stress were disconnected from reality.3 Specifically, stress related to school pressure and family finances had a greater impact on young people than parents believed. Teens and tweens were more likely than parents to say that their stress had increased within the last year. Only 2–5% of parents rated their child’s stress as extreme when 14% of tweens and 28% of teens said they worried a lot or a great deal. Psychologists say that if they don’t learn healthy ways to manage stress early in life, it could have serious long-term health implications.3

How can clinicians support young patients suffering from symptoms related to stress, addiction, and chronic pain? That was the focus of a pediatric track at IFM’s Annual International Conference (AIC), “Stress, Pain, and Addiction: Transformative Treatments and Innovative Solutions,” May 30–June 1, 2019, in San Antonio, TX. In the video below, IFM educator Elizabeth Mumper, MD, FAAP, talks about the pediatric track, which will include a panel discussion, breakout sessions, an audience Q&A, and clinical tools.

As a steering committee member for IFM’s 2019 Annual Conference, Dr. Mumper has guided the selection of topics and speakers.

A 2017 metasynthesis supports the claim that for many people, addiction is closely related to early-life stress or trauma.2 Participants in the study described early-life stress associated with physical, emotional/psychological, and sexual abuse, physical neglect, and emotional neglect. Others reported stress related to parental loss, divorce, and abandonment. Regardless of when the addictive behavior itself began, a common factor among participants in the study is that addiction in adulthood is a way of coping with the effects of early-life stress.2 With this information, clinicians can encourage patients to talk about their current and past stressors and help them manage stress levels by developing healthy coping mechanisms.

Research suggests that early-life stress and trauma can result in permanent changes in HPA-axis function, morphological changes in the brain, and gene expression changes, all of which are implicated in the abuse of psychoactive substances.4 Stress and pain are also closely connected. In a 2018 study, the prevalence of post-traumatic stress disorder (PTSD) symptoms in a chronic pain population (28%) greatly exceeded the prevalence of PTSD in the general population (7%).4 Patients with chronic pain who screened positive for PTSD reported higher pain severity and were younger.5

Poorly managed pediatric stress and pain not only affects the quality of life of children and their families, but also puts children at risk for continued and heightened impairment as they move into adulthood.6

Related Articles:


  1. Institute of Medicine Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011. doi:10.17226/13172.
  2. Teixeria CAB, Lasiuk G, Barton S, Fernandes MN, Gherardi-Donato EC. An exploration of addiction in adults experiencing early-life stress: a metasynthesis. Rev Lat Am Enfermagem. 2017;25:e2939. doi:10.1590/1518-8345.2026.2939.
  3. APA survey raises concern about parent perceptions of children’s stress. American Psychological Association. Published November 3, 2009. Accessed November 8, 2018.
  4. Enoch MA. The influence of gene-environment interactions on the development of alcoholism and drug dependence. Curr Psychiatry Rep. 2012;14(2):150-158. doi:10.1007/s11920-011-0252-9.
  5. Akhtar E, Ballew AT, Orr WN, Mayorga A, Khan TW. The prevalence of post-traumatic stress disorder symptoms in chronic pain patients in a tertiary care setting: a cross-sectional study [published online July 29, 2018]. Psychosomatics. doi:10.1016/j.psym.2018.07.012.
  6. Martin SR, Zeltzer LK. Prioritizing pediatric chronic pain and comprehensive pain treatment in the context of the opioid epidemic. Pain Manag. 2018;8(2):67-70. doi:10.2217/pmt-2017-0072.

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